World News

Gary Culliton brings you a round-up of the healthcare news making headlines around the world.

Global support for medics’ appeal

The Australian Medical Association (AMA) has backed the direct appeal by the World Medical Association (WMA) to the King of Bahrain to ensure a fair retrial for the doctors and other health professionals who have been convicted for treating people who were injured during recent civil unrest. AMA President Dr Steve Hambleton said that the Association supported the WMA’s appeal to the King of Bahrain to protect medical personnel in the country.

“There are doctors and other healthcare workers who risk their own lives to help those living in areas of conflict and unrest,” Dr Hambleton said. “Putting these medical personnel on trial for fulfilling their ethical duty to care for others is a threat to the universal right to health and healthcare.

Where the safety of medical personnel is not adequately protected during times of conflict, many sick and wounded people simply do not receive the healthcare they need.

“We hope that the doctors and healthcare workers in Bahrain will receive a fair trial in a civilian court. The AMA will always champion the rights of doctors to fulfil their duty of care to people in conflict situations,” Dr Hambleton said.

The New Zealand Medical Association (NZMA) also stated that assertive action was needed to protect health workers in political hotspots, particularly in light of the situation in Bahrain. “They have been charged with conspiring against the Bahraini government when in fact they were undertaking their ethical obligation to treat all patients without regard to politics, race or religion,” said NZMA Deputy Chair Dr Mark Peterson.

Doctors’ leaders in Britain have welcomed news of a civilian court retrial for 20 Bahraini healthcare workers. The British Medical Association (BMA) has been pressing the Bahraini government to deal fairly with the workers, who were arrested after pro-reform protests earlier this year. In September, they received sentences of up to 15 years following a military court case. But Bahrain’s public prosecutor has ordered a ‘retrial’ in a civilian court. BMA Director of Professional Activities Vivienne Nathanson welcomed the news and pledged the BMA would continue to call for a fair trial.

As one of the 26 members of the WMA Council that signed a joint letter to King Sheikh Hamad bin Isa Al Khalifa (pictured) at the WMA’s Council meeting in Montevideo, Uruguay, the South African Medical Association (SAMA) said it “stands firm in appealing to the King to reinstall the elected leadership of the Bahrain Medical Association (BMA) following its recent takeover by Bahraini government”.

The doctors, nurses and paramedics initially sentenced to up to 15 years in prison launched an appeal on October 23. While the government portrayed the hearing as a new trial, human rights groups disagreed and have called for the verdicts to be completely overturned. It is understood the next hearing is set for November 28.

Doctors can help tackle social determinants

Doctors have a key role to play in reducing health inequalities, according to a new report.

‘Social Determinants — What Doctors Can Do’, published by the British Medical Association (BMA), sets out how doctors can use their expertise to act as community leaders to tackle this issue. Dr Vivienne Nathanson, Director of Professional Activities at the BMA and author of the report, indicated that factors that impact on health and well-being over which there is little control, for example, include where a person is born, grows up, lives and works, as well as gender and age.

She explained that while these factors were not usually directly responsible for ill health, they have been described as the causes of the causes of disease. For example, while smoking may lead to heart disease and lung cancer, it is the social factors that largely determine whether an individual is more or less likely to smoke, and if they start to smoke, whether they are likely to quit successfully.

Dr Nathanson highlighted examples of work doctors and their teams are already involved in, including the Bromley-by-Centre in East London, where GPs refer patients to professionals from welfare, employment, housing and debt advice services so that the underlying causes of their health problems can be addressed. Other examples cited in the report include doctors working with homeless people in Glasgow and clinicians at the Royal United Hospital in Bath developing training programmes to help staff improve the care they provide to profoundly deaf patients.

“We will urge the General Medical Council and the medical royal colleges to include an understanding of social determinants in examinations syllabi for future doctors,” Dr Nathanson said.

Deficiencies in pain management — WMA
Two major reasons for gaps in pain treatment were a lack of education for health professionals in the assessment and treatment of pain, and unnecessarily restrictive government regulations, including limiting access to opioid pain medications, the World Medical Association (WMA) has said.

Tens of millions of people with cancer and other diseases and conditions are experiencing unnecessary pain without access to adequate treatment, according to the WMA. At its annual General Assembly in Montevideo, Uruguay, the WMA put forward a series of proposals to improve patients’ access to adequate pain treatment.

It said that in most cases, pain could be stopped or relieved with inexpensive and relatively simple treatment, which could dramatically improve the quality of life for patients. Such patients faced severe suffering, often for months on end, and many eventually died in pain — which was unnecessary and almost always preventable and treatable, said the WMA. Children and people with intellectual disabilities were especially at risk of receiving inadequate pain treatment.

Dr Mukesh Haikerwal, Chair of the WMA, said: “Physicians and other healthcare professionals have an ethical duty to offer proper clinical assessments to patients with pain and to offer appropriate treatment. This may require prescribing medications, including opioid analgesics. We would like to see instruction on pain management included in the mandatory curricula and continuing education for physicians and other health professionals. And governments must ensure the adequate availability of controlled medicines, including opioids, for the relief of pain.”

WHO issues a warning on TB underfunding
The number of people falling ill with tuberculosis (TB) each year is declining for the first time, a World Health Organization study has shown.

New data, published in the WHO 2011 global tuberculosis control report, also reveals that the number of people dying from the disease fell to its lowest level in a decade. Yet, current progress — especially efforts to combat drug-resistant TB — are at risk from underfunding, the WHO said.

The new report found that the number of people who fell ill with TB dropped to 8.8 million in 2010, after peaking at nine million in 2005, and TB deaths fell to 1.4 million last year, after reaching 1.8 million in 2003. The TB death rate dropped 40 per cent between 1990 and 2010 and all regions except Africa are on track to achieve a 50 per cent decline in mortality by 2015. In 2009, 87 per cent of patients treated were cured, with 46 million people successfully treated and seven million lives saved since 1995. However, a third of the estimated TB cases worldwide are not notified and therefore it is unknown whether they have been diagnosed and properly treated.

Worldwide, the share of domestic funding allocated to TB rose to 86 per cent for 2012. But most low-income countries still rely heavily on external funding. Overall, countries have reported a funding shortfall of US$1 billion (€708 million) for TB implementation in 2012.

“Fewer people are dying of tuberculosis, and fewer are falling ill. This is major progress. But it is no cause for complacency,” said United Nations Secretary-General Ban Ki-moon. “Too many millions still develop TB each year and too many die. I urge serious and sustained support for TB prevention and care, especially for the world’s poorest and most vulnerable people.”

In many countries, strong leadership and domestic financing, with robust donor support, has started to make a real difference in the fight against TB, added the WHO’s Director General Dr Margaret Chan. “The challenge now is to build on that commitment, to increase the global effort and to pay particular attention to the growing threat of multidrug-resistant (MDR) TB.”

A new rapid test for MDR-TB is revolutionising TB diagnosis, with 26 countries using the test only six months after its endorsement by WHO last December and at least 10 more countries expected to have it by the end of 2011.

Medicare pay cuts of 30 per cent loom

Doctors in the US have launched a television and radio advertising campaign to urge patients and physicians to tell Congress that the time for repeal of the broken Medicare physician payment formula is now, as the formula will trigger a cut of nearly 30 per cent on January 1 if action is not taken.

Physician payments under Medicare have been nearly frozen for a decade, leaving a 20 per cent gap between payment updates and the cost of caring for seniors. A drastic cut of nearly 30 per cent is the largest ever scheduled and will force many physicians to limit the number of Medicare patients in their practice, according to the American Medical Association (AMA). This, the Association believes, threatens access to care for seniors and baby boomers in Medicare and military families who rely on TRICARE.

“Congress has repeatedly put in place short-term fixes to stop the drastic cuts caused by the Medicare physician payment formula, but that is not a solution — it is procrastination,” said AMA President Dr Peter W Carmel.

“These budget tricks only make the problem worse. It is time to solve this problem once and for all.

“Repeal of the Medicare physician payment formula is the fiscally responsible action for the congressional deficit committee; it has wide public support and bipartisan congressional support,” said Dr Carmel.